- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,408.10 / $9,062.00 / $18,276.00
| Facility | | $2,408.10 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.82 / $27,416.96 / $43,667.88
| Facility | | $12,114.82 | $27,416.96 | $43,667.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $2,410.14
| Facility | | $890.00 | $890.00 | $2,410.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.31 / $238.31 / $238.31
| Facility | AS | $238.31 | $238.31 | $238.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,305.44 / $2,976.00 / $4,660.08
| Facility | | $2,305.44 | $2,976.00 | $4,660.08 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $508.91 / $600.20 / $881.56
| Facility | 80 | $508.91 | $600.20 | $881.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $356.23 / $420.14 / $617.09
| Facility | AS | $356.23 | $420.14 | $617.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |